›› WHAT IS CERVICOGENIC HEADACHE?
Cervicogenic Headache is a relatively new medical term and it refers to
headaches, which originate from tissues and structures in the cervical spine
or neck region. It has been quiet a few years since recognition but the
exact mechanism of cervicogenic headache is still unclear. Perhaps
quotations of several specialists in this area will give you better idea of
a nature and symptoms of the condition.
Excerpts:
Daniel J. Hurley, M.D.
Whether from chronic tension or acute whiplash injury, intervertebral disc
disease or progressive facet joint arthritis, the neck can be a hidden and
severely debilitating source of headaches. Such headaches are grouped under
the term “cervicogenic headache”, indicating that the primary contributing
structural source of the headache is the cervical spine. There are well
mapped out patterns of headache relating to a multiplicity of muscular
trigger points in the neck and shoulder-blade (or peri-scapular) region, as
well as to disc and joint levels in the upper cervical spine. Even headaches
located predominantly in the forehead, or behind, in and around the eyes are
very often “referred” pain zones for pathology located in the back of the
neck and at the base of the skull. This base of the skull area is called the
suboccipital region, because it is below the occipital part of the head. The
joints connecting the top two or three levels of the cervical spine to the
base of the skull handle almost 50% of the total motion of the entire neck
and head region, thus absorbing a continuous amount of repetitive stress and
strain, in addition to bearing the primary load of the weight of the head.
Fatigue, postural malalignment, injuries, disc problems, joint degeneration,
muscular stress and even prior neck surgeries all can compound the wear and
tear on this critical region of the human skeletal anatomy. One may also
develop a narrowing of the spinal canal itself, through which runs the
spinal cord and all of its exiting nerve roots, leading to a condition
termed spinal stenosis, also a possible source of headaches, among other
symptoms.
Mary Jo Curran, MD
At this point we can’t point to the exact (even smallest) c-Spine
abnormality as a definite source of cervicogenic headache. Ascending fibers
from the C1 and C2 nerve roots are intimately involved with the trigeminal
nucleus at the level of the brainstem. The nociceptive afferents from the
trigeminal nerve and the receptive fields from the first three cervical
nerves converge in the trigeminocervical nucleus. The structures innervated
by C1-3 are capable of causing headache. These structures include muscles,
joints, a portion of dura, ligaments, and the vertebral arteries.
Lower segmental levels and the cervical facet joints C2-3 and C4-5, have
also been described as contributing to cervicogenic headache. There is a
case report of a C6-7 disc herniation as the cause of a 15-year unilateral
headache. The patient developed a C7 radiculitis and a C6-7 disc
decompression alleviated the long-standing headache. The C2 and C3 nerve
roots may also be the source of headache. The C2 ganglion may be injured by
whiplash.
Differentiating between cervicogenic headache and other forms of headache is
difficult because there may be variability in presentation and also
considerable symptom overlap. Diagnostic injections have a role in not only
differentiating different types of headaches, but also identifying the pain
generator. Diagnostic injections of the cervical facet joints (or medial
branch blocks), blocks of the cervical nerves, cervical discography,
sphenopalatine and sympathetic blocks often times will elucidate the
etiology of pain.
Since there are no consistent findings on physical exam, many authors
recommend diagnostic C2 root and ganglion blocks should be considered to
differentiate cervicogenic headache from migraine, chronic paroxysm
hemicrania, hemicrania continua and tension-type headaches.
Some More News